What does “dual plane” mean?

Dual-plane breast augmentation refers to the placement of a breast implant in a specific anatomic position — partly behind the pectoralis muscle, and partly behind breast tissue. The layers of the breast, from external to internal, are skin, breast tissue, pectoralis muscle and ribs. Plastic surgeons have debated the best plane for implant placement over many decades — some preferring placement between the breast tissue and the muscle (the “subglandular plane”), and others preferring placement between the muscle and the chest wall (the “submuscular plane”). There are advantages and disadvantages to each. The “dual plane” was first described by Dr. John Tebbets in 2001 as a way to combine the advantages of both.

A Closer Look At The Dual-Plane Breast Augmentation process

In the dual plane approach, the lower origin of the pectoralis muscle is detached from the chest wall and separated from the lower part of the breast tissue. This allows the muscle to slide upward slightly. When the implant is placed, the upper portion is covered by muscle and breast tissue, while the lower portion is covered by breast tissue alone. The upper muscle coverage of the implant reduces the risk of rippling and implant visibility in the upper part of the breast, capsular contracture, and disruption of cleavage (synmastia), while improving mammography accuracy. At the same time, the lower part of the breast implant that is covered by breast tissue benefits from a smoother implant-breast transition, enhanced shape, and a more natural look and feel.

The Benefits of the Dual Plane Method

The dual plane technique comes in very handy in cases of breast deflation with ptosis (sagging), which occurs after having children, breastfeeding, losing weight, or naturally with time. In these cases, a dual plane allows the implant to be placed slightly lower to fill the lower pole of the breast and give a lifted appearance during breast augmentation. This does not replace the need for breast lifting (mastopexy) in moderate to severe cases, but it does occasionally prevent the need for lifting in more mild cases.

Bigger is not always better when it comes to breast size. Many women who have large breasts consider breast reduction surgery because of back pain, difficulty finding clothes that fit, and overall discomfort. Those who are bothered by the size of their breasts should consider these five signs that it might be time to think about a reduction.

1. Severe Back Pain

Excess weight on the chest pulls shoulders forward, compressing nerve fibers in the back and causing serious pain. Some women also have headaches, shoulder pain, arm numbness, and nerve damage. The larger the breasts, the more pressure that is put on this area. With age, these effects also tend to increase.

2. Skin Rashes

With physical activity, sweat and dirt are easily trapped under the breasts, irritating the delicate skin in that area. This can lead to an itchy, painful red rash that often becomes chronic.

3. Trouble Breathing, Especially During Activity

The weight of large breasts can make breathing a challenge, particularly for women who are back sleepers. This, in turn, makes it more difficult for women with large breasts to exercise and maintain a healthy weight. Challenges are often experienced during activities like running, aerobics, yoga, swimming, and team sports. While there are sports bras designed to support large breasts for physical activities like these, they are often costly and difficult to find.

4. Shoulder Disfigurement

Over time, women with large breasts may develop permanent grooves in the shoulders caused by bra straps pulled downward by the weight. Other women find that they become hunched over and are unable to maintain healthy posture because of their breasts.

5. Clothing Difficulties

Shopping for flattering apparel can be challenging for women with large breasts, especially when it comes to functional items like swimsuits. Many women also feel uncomfortable in clothing that emphasizes the breasts, and they may be concerned about unwanted attention. Self-consciousness is often compounded when large breasts are sagging or asymmetrical.

If these issues sound familiar, Dr. Jeffrey H. Donaldson offers breast reduction surgery that is catered to your body and your personal goals. Women can explore video reviews from others who have had this procedure. Our caring, professional staff is committed to the privacy, comfort, safety, and thorough satisfaction of our patients. Call our Columbus office today at 614-442-7610.

For many women, the decision to get a breast augmentation is a process that requires several different factors before reaching the final decision. One such factor that is often quite difficult is choosing the right size — not too large, not too small — for the implants. We know that breast size affects many aspects of a woman’s life, including her relationships, social interactions and overall physical well-being. We want to make sure that patients have the resources and guidance to choose the perfect implant size!

Here are some of the most important factors to consider and discuss with your surgeon before settling on what implant size to choose for your breast augmentation.

Body Measurements

We all know that bra cups are typically sized in A, B, C and up, but implants are measured in cubic centimeters — cc for short. For approximately every 150 to 200 ccs, the breasts will usually increase about one or one and a half cup sizes. That can vary a bit depending on your specific measurements and even the bra manufacturer, but it gives you an idea! You can always try on different sizes with specialized bras during your consultation to see how the implants look and feel on your body.

With such a large range of sizes, it’s important to realize that not every woman’s body type and breasts will be able to handle implants higher up on the scale. Your body type, including the width of your natural breasts and shape and size of the chest wall, will factor into the ideal size of implant to create the desired fullness, shape, and profile.

Body Shape & Frame

It should come as no surprise that larger breasts, whether natural or augmented, are heavy. This can take a toll on a woman’s entire body. Women with larger frames and/or stronger muscles are best equipped to handle large breast implants, but even they can be susceptible to issues. Choosing a too-large breast implant size can lead to fatigue, back and shoulder pain, and potentially even the need for a breast reduction.

Depending on your frame, a high, moderate, or low profile may work best. For those with a small frame, a high profile may be ideal because this option has a narrower width. While a low volume option may work for those with broad shoulders and a larger frame to create an even proportion.

Lifestyle Factors

Now that we have covered several body-related factors to consider, it’s time to talk about lifestyle. For active women, athletes, or women with more physically demanding jobs, larger breast implants may not be ideal. It’s simple: the larger the breasts, the more tiresome and potentially painful it will be to carry the extra weight while working, running, lifting weights or playing a sport.

It’s also important for you to think about what kinds of clothing you normally like to wear, and if those items will be compatible with larger breast implant sizes. Augmentation will certainly affect how shirts, bras, swimsuit tops, and dresses fit, and additional procedures like lifts or reconstructions will affect things even further.

There’s a lot to think about when deciding on breast implant sizes! If you’re considering breast augmentation surgery and wondering if it’s right for you, we would love to see you at Donaldson Plastic Surgery. Dr. Donaldson will perform a personalized consultation that takes into account your specific anatomy and the results you’re looking for. He and his surgical assistant, Bobbie, will work with you to determine the best option according to your body shape. Call today to schedule a consultation and we can help make sure that you get the best results from your breast augmentation surgery.

The chest can cause a significant amount of discomfort and distress for transgender individuals. The breasts, in particular, are one of the most gender-identifying features and should strongly reflect a person’s identity.

Top surgery (breast augmentation) can provide a transgender woman with the shapely, feminine breasts she desires to better match her gender identity. Dr. Donaldson understands that the journey to self-discovery for a transgender patient can be complex and arduous. We treat all of our patients with sensitivity and care, and our goal is to help make inner confidence more apparent externally.

Here are 3 things to consider when selecting a doctor to perform your Male to Female Top Surgery.

1. Experience and Expertise

A board-certified plastic surgeon has completed a thorough residency, masters program, and medical school, and must demonstrate proficiency in all areas of plastic surgery before taking the board exams. A board-certified plastic surgeon has the training necessary to ensure safe, beautiful results. It is also critical that your surgeon has experience with the intricacies required to ensure a natural result.

2. Reviews and Testimonials

Dr. Donaldson and his surgical team are extremely proud of their work and our patients are beyond happy with their results. A quick look at our reviews and testimonials will tell you as much. When selecting a surgeon we always suggest reading patient reviews to hear first-hand about former patient experiences. Look for a doctor who is proud of their patient reviews.

3. Personal Connection

Choosing to undergo top surgery is a major decision and it’s completely normal for patients to be nervous, scared, or anxious about it. One of the most important factors during this process is to feel understood by the surgeon performing the procedure. Test the staff as well – they will also be a huge part of your experience, and they should provide experience and care.

On Thursday, February 8th, 2019, the Food and Drug Administration (FDA) issued a report about Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) to health care providers inside and outside of the field of plastic surgery to raise general awareness, promote accurate diagnosis, and hopefully ensure more timely treatments. Dr. Donaldson and the staff at Donaldson Plastic Surgery support and advocate the FDA’s efforts to gather and disseminate accurate information. BIA-ALCL is a rare form of cancer that has been studied extensively by the plastic surgery community for the past several years. As a practice, we strive to be a trusted resource for all of our past, current, and future patients. Dr. Donaldson has attended national presentations, stayed up-to-date with clinical reports, followed best-practice recommendations, and communicated closely with his colleagues, staff, and patients regarding this topic. Fortunately, out of nearly ten million patients worldwide who have had breast augmentation surgery, only 457 have had a confirmed diagnosis of BIA-ALCL. All of these cases have been associated with the use of textured breast implants. Dr. Donaldson has NEVER used this type of implant. We have compiled the following information to present what is currently known about BIA-ALCL, including the risks, frequency, diagnosis, and treatment of this condition.

Our Surgical Process During Breast Augmentations

First, we will provide a description of our typical breast augmentation surgical technique. After a small skin incision, Dr. Donaldson separates tissue to create a pocket for the breast implant. Before implantation, the pocket is irrigated with an antibacterial solution to ensure a clean environment. The implant is then opened from its sterile packaging and, using a separate pair of sterile surgical gloves, Dr. Donaldson is the only person who directly handles the implant. It is rinsed with the antibacterial solution and compressed through the incision into the surgically-created pocket. The correct positioning is confirmed, and the pocket is closed with a series of dissolvable sutures. The operation typically takes less than an hour. The healing process begins almost immediately as the body’s immune system triggers a normal “foreign body” reaction that causes scar tissue to develop around the implant. Over time, the tissue completely encloses the implant, creating a capsule that separates the implant from the breast tissue.

The Importance of a Sterile Environment

One of the primary goals throughout the surgery is to ensure that the skin, pocket, and implant are kept completely sterile to minimize exposure to bacteria or other contaminants. Dr. Donaldson and the entire operating room staff go to great lengths to maintain sterility through the use of “minimal-touch” and “no-touch” techniques; antibacterial solutions; nipple guards; IV antibiotics; and, in some cases, implant delivery devices that reduce implant-skin contact. It is nearly impossible to prevent every bacterium from the skin and/or bloodstream from adhering to the implant. This normal process creates a biofilm between the implant and the newly-forming capsule. The body’s immune system can comfortably handle this minimal bacterial load unless a critical point is reached where the bacterial levels are high enough to trigger a chronic inflammatory response.

If the immune system develops a chronic inflammatory response, it is usually delayed a year or more after surgery and is affected by individual genetics and immune status. A chronic inflammatory response to the implant and biofilm has been linked to capsular contracture, additional scar tissue that can be seen and felt through swelling, tightening, or firming of the breast and a change in breast shape or position. Capsular contracture is graded on a scale of I-IV, and Dr. Donaldson prefers to treat the more severe grades III and IV through re-operation with capsule release and/or implant removal and/or replacement. The risk of capsular contracture occurring is less than 5 percent.

The biofilm that develops after an implant is inserted into the breast is commonly suspected as the cause for BIA-ALCL. When a chronic inflammatory response is not severe enough or fast enough to create a capsular contracture, it may lie dormant as a mild, long-term, low-grade infection inside of the capsule. Over a 7-10 year period, this underlying condition is believed to cause an immune T-cell abnormality that then progresses to BIA-ALCL. The first symptom is usually a late-onset seroma, or fluid collection, which causes swelling of the breast, asymmetry, and/or pain. In these early stages, the lymphoma resides inside of the protective capsule and is not connected to the breast tissue.

BIA-ALCL’s Connection to Textured Breast Implants

Biofilm seems to be more problematic with textured implants. In the late 1960s, textured-surface implants were designed in an attempt to reduce the rate of capsular contracture. Early results showed promise, but ten-year follow-up studies demonstrated that the texture of the implant does not affect the rate of capsular contracture. Since then, smooth, round implants have been preferred by most plastic surgeons in the United States, while textured implants have been more popular in Europe and South America. The recent introduction of shaped, highly-cohesive anatomical implants has increased the use of textured-surfaces because these implants cannot be permitted to flip or spin.

In contrast to a round implant that can flip or spin in the breast pocket with no visible difference, movement of an anatomically-shaped implant creates an unattractive breast shape that may cause the breast to appear sideways or upside-down. The texturized surface of an anatomically-shaped implant causes the capsule to grip the implant and prevent movement within the pocket. Dr. Donaldson does not use textured implants, and he does not use anatomical implants. He exclusively uses smooth, round implants.

Of the FDA-confirmed 457 cases of BIA-ALCL, no cases with purely smooth breast implants have been reported in any series, registry, or case with a detailed history. The texture on the outside shell of an implant may hinder the elimination of biofilm-creating bacteria due to the irregularity of the surface, multiple crevices, and increased surface area. Studies show significantly more bacterial adherence to textured versus smooth implant surfaces, as well as an increased number of lymphocytes–the cells that can become abnormal in cases of lymphoma.

Current Methods of Diagnosing and Treating BIA-ALCL

If symptoms arise, it is imperative to consult with a board-certified plastic surgeon. If a patient’s history and exam seem suspicious, the surgeon will order tests that look for fluid around the implant. If a seroma or mass is detected, the fluid will be sampled and/or the tissue will be biopsied. Tests will then reveal whether known markers of BIA-ALCL are present. If confirmed, the surgeon will collaborate with an oncological team to create a plan for treatment. In early-stage disease, the implant and capsule are completely removed with no need for chemotherapy or radiation. Current three-year follow-ups show that 93 percent of patients are disease-free when following this protocol. If reports of symptoms, diagnosis, or treatment are delayed, then the lymphoma may spread and become systemic. The FDA has reported 9 known deaths in the US from BIA-ALCL. None of these patients received complete surgical excision or the targeted therapy that is now recommended.

Although our understanding of BIA-ALCL has improved dramatically over the past decade, further studies are underway, which should provide additional information. The FDA’s recent announcement was intended to increase awareness and encourage more health care providers to take part in the identification of BIA-ALCL. As a practice, Donaldson Plastic Surgery records all implant information in case future evaluation becomes necessary. To date, we have diagnosed ZERO patients with BIA-ALCL. Nonetheless, Dr. Donaldson is prepared to follow the most current diagnostic and treatment protocols, including radiographic imaging, fluid sampling, and immediate removal of the implant and capsule.

Our patients can confirm that their safety and wellbeing is our top priority. We believe that all of the risks associated with plastic surgery should be discussed and properly understood. There are approximately 300,000 breast augmentations in the United States every year. Given the extremely low overall incidence of BIA-ALCL, its exclusive association with textured implants, and its excellent prognosis with timely diagnosis and treatment, we continue to believe in the safety of smooth, round breast implants and the positive impact that breast augmentation has had on our patients’ lives.

The age of fitness influencers is upon us. Not only are they selling us waist trainers and flat tummy teas, they are selling us the design of today’s “perfect” body standard: a teensy waist and a butt for which Sir Mix-a-Lot would come out of retirement.

While these curvy frames are popular now, they haven’t always been en vogue. The “ideal” female body has seen a lot of change throughout time; much like fashion trends, body ideals change to reflect pop culture, making many women feel like they have to fit a certain mold to feel beautiful.

Cassey Ho, the fitness guru behind Blogilates, recently took to Instagram to give us all a much needed wake-up call. Using her own image and some PhotoShop magic, she edited her own body to show the most desirable body shapes throughout the last few hundred years.

Inspired by Cassey, we decided to take a look at the “perfect” body type of some of society’s defining eras:

Of course, the 2010s have seen the rise in popularity of exaggerated curves and big butts. There are many reasons why this figure dominates the media, but it is largely due in part to celebrity influence. Also, as notions of beauty in mainstream media have become more culturally diverse, an ample backside has become a more desirable trait for many women around the world.

2000s: Large Breasts, Long Legs

Rewinding to the early 2000s, large breasts and long slim legs were idealized as the peak of femininity. Instead of the butt, breasts took center stage as the most desirable feature for women.

1990s: Extremely Skinny

In the 1990s, the skinny revolution was in full force. The idea that ‘skinny’ meant ‘healthy’ was a pervasive one in media messaging, and women were restricting their intake like never before to achieve the look. Supermodels like Kate Moss and Naomi Campbell in magazines and fashion campaigns reinforced the message.

1950s: Hourglass

Moving back in time to the 1950s, the hourglass figure was the ideal body shape for women. Popularized by Hollywood starlets like Elizabeth Taylor and Marilyn Monroe, women considered to represent the apex of 1950s beauty, the hourglass shape included an ample bosom, miniscule waist, and full hips. Much like today, shapewear was all the rage to achieve this voluptuous figure.

1920s: Boyish

The 1920s were defined by slender and androgynous bodies, perfectly suited for flapper attire. Angular bodies with a svelte physique were considered attractive, resulting in many women feeling pressure to bind their breasts to minimize their figure.

1400 – 1700s: Full, Curvy

From the 15th century to the 18th century, full bodied figures were considered to be the most beautiful. Having ample proportions meant that one was well-fed, therefore indicating wealth and status and making one more desirable to potential suitors.

What This Means For Women Today

With all of these examples, it is easy to see there is a societal cause behind every ideal body type throughout time. As the world around us changes, so too does our perception of what it means to be beautiful. So what does this mean for women today?

Treating our bodies like fashion trends means that there will always be something new to change. At its core, our desire to fit in with trends is really a desire for happiness and acceptance – however, if we can learn to love our own brand of beauty, the happier we will be. Instead of letting society dictate our choices, focusing on individual needs and desires will allow us to truly shine.

One Size Does Not Fit All

Here at Donaldson Plastic Surgery, we understand that there is no one-size-fits all approach to feeling beautiful. Our team of specialists has lots of experience working one on one with patients to understand their unique goals, desires, and vision for themselves. After all, we believe beauty is rooted in confidence, and it starts with becoming the very best version of yourself.

Our message is a simple one: fashion may fade, but confidence is timeless.

In 2011, I came to Dr. Donaldson and got a breast augmentation and a mini tummy tuck; and eight years later, I decided to come right back to Dr. Donaldson again because I trusted him and because he did such amazing work before, I trusted him to do it again. You’re probably wondering, “why’d you have to come back in eight years?”. Well, I mean, your body fluctuates within eight years – gaining weight, losing weight, gaining weight, losing weight– and I just wasn’t happy with what I had up here anymore. I thought “you know what? it’s time for a little pick-me-up”, so that’s exactly what Dr. Donaldson gave me again. I couldn’t be happier with the results that I have. I recommend everyone to come to Dr. Donaldson. I even live in Cleveland, just FYI. I used to live in Columbus, which is why I went to him, and I moved to Cleveland to be with my husband; and he drove me down to get my surgery done because that’s how much I trust and believe in Dr. Donaldson. So, come to him! I trust him and you should too!

*Note: Patient results will vary. All video testimonials were voluntarily submitted by actual patients with permission to publish on our website. Testimonials or statements made by any person(s) within this site are not intended to guarantee outcomes.

As our patients know firsthand, the safety and well-being of our patients are always at the heart of everything we do.

You may have heard that Allergan, the makers of many silicone breast-implants, has recently issued a recall of one style of breast implant they provide. A recent publication provided by the U.S. Food and Drug Administration (FDA) detailed the uncommon incidence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and its relation to the Allergan textured breast implants. The recall specifically targets the BIOCELL® textured breast implants and tissue expanders.

Our practice does not use, nor has ever used, textured implants. We have only ever used smooth, round breast implants, so this recall does not affect our patients. Still, Drs. Donaldson and Sieffert recognize this recall as an opportunity to help educate our community about illnesses related to breast implants and to put worrying minds at ease.

If you have any concerns over this recall, please note that the condition is treatable when it’s diagnosed and treated early by a medical professional. Scheduling an ultrasound as soon as possible is recommended; however, our patients should not be affected by this condition.

Watch our above video of plastic surgeons Dr. Donaldson and Dr. Sieffert discussing the recall and their recommendations for patients who may be worried about the possibility of developing BIA-ALCL.

In addition, if you ever have any concerns about your breast implants or other cosmetic surgery procedures, contact the team at Donaldson Plastic Surgery & Aesthetic Solutions.

Just this past weekend, an online advertisement encouraged patients from the United States to have elective breast surgery in India — see link. The ad suggests that these operations are offered “at a fraction of world costs with comparable success rates and service levels.” This type of medical tourism has begun to flourish in Asia and South America as well.

Dr. Donaldson has helped to teach plastic surgeons from India, Turkey, Japan, Columbia, Mexico and New Zealand, and he has a great amount of respect for international plastic surgery; however, he does not recommend traveling to a foreign country to save money on breast augmentation. Columbus, Ohio residents are fortunate to have a
world-class option right at home with Jeffrey Donaldson, MD.

There are many reasons to avoid medical tourism: any savings from surgery are spent on travel; surgeon reputation and patient outcomes may be difficult to determine; language barriers can hinder communication between doctors and patients about goals and expectations; pre-operative testing and post-operative care is abbreviated or eliminated in order to get patients home more quickly.

Dr. Donaldson’s patients enjoy personalized consultations, medical examinations and pre-operative clearance in Columbus, Ohio. Breast augmentation surgery is then followed post-operatively with careful observation and encouragement by Dr. Donaldson and his staff. Any concern that may arise is handled with compassion, immediacy, and great expertise —
without the need for boarding a plane!

The first decision in breast augmentation is where to place the incision. How long will it be? Will it show?

One option is to hide the incision in the fold beneath the breast. This location tends to blend in well over time, but the position must be precise so that it does not rise up onto the lower part of the breast or sink down to the upper part of the abdomen. It is easy to make this incision longer if necessary to accomodate a larger implant.

Another option is to place the incision along the curve of the nipple/areola, in a half-circle that hides between the lighter skin of the breast and the darker skin of the areola. This approach makes sense if changes in the shape of the areola are desired, a small “lift” is planned or the fold under the breast is too exposed. The length of incision is limited by the size of the areola.

Finally, for many women in Columbus, Ohio, breast augmentation is only desirable when there are no incisions on the breast at all. These patients opt to have their implants placed through the axilla or armpit. The small scar fades fast, and it is best for saline implants that are placed under the pectoralis muscle. It requires specialized endoscopic equipment and training to achieve optimal results.

Many surgeons learned one way to perform breast augmentation, and they still use the same incision every time. For breast augmentation, Columbus, Ohio surgeon Dr. Jeffrey Donaldson trained with leaders in the field nationwide, and he is comfortable offering each patient a personalized, customized approach. He will help you choose an incision that suits your individual needs and preferences.

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